Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Cardiovascular Epidemiology Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Int J Cardiol. 2019 Feb 1;276:81-86. doi: 10.1016/j.ijcard.2018.09.005. Epub 2018 Sep 12.
The significance of depression/anxiety among ACHD patients in terms of health care utilization is unknown and data on the association with mortality are scarce.
Analyses comprised 8334 ACHD patients, age ≥ 18 years, insured by a large healthcare organization (2007-2011). Depression/anxiety were determined by diagnoses and treatments recorded in the organization database. Adjusted utilization relative rates (RRs) were estimated with negative binomial models and mortality hazard ratios (HRs) with the Cox proportional hazard model.
ACHD patients with depression/anxiety (N = 2950, 35%) were more likely to be older (mean ± SD: 54 ± 17 vs. 45 ± 18 years), women (61% vs. 45%), and have comorbidities than counterparts without depression/anxiety. Following multivariable adjustment, patients with depression/anxiety had more primary care and cardiology clinic visits, more emergency department visits and more hospitalizations. RRs (95% confidence interval) were: 1.31 (1.27-1.35); 1.07 (1.01-1.13); 1.60 (1.46-1.77); and 1.18 (1.08-1.29) respectively, for diagnosis before the study period, and 1.36 (1.31-1.42); 1.22 (1.14-1.30); 1.43 (1.24-1.60) and 1.47 (1.33-1.64), respectively, for diagnosis during the study. Stratifying by age, the highest adjusted primary care and cardiology visit RRs were found among 18-24 years old patients and the lowest among patients ≥65 years. Between 2007 and 2017, 905 patients died. Depression/anxiety were associated with increased mortality risk with adjusted HRs: 1.10 (95% CI: 0.94-1.29) for past diagnosis and 1.40 (1.17-1.67) for study period depression/anxiety diagnosis.
Depression/anxiety in ACHD patients is associated with increased health-care utilization and a higher risk of death. The efficacy of addressing patients' psychosocial needs in optimizing health-care utilization and improving prognosis needs further evaluation.
目前尚不清楚成人先天性心脏病（ACHD）患者的抑郁/焦虑症状在医疗保健利用方面的意义，且有关其与死亡率关联的数据也较为匮乏。
本分析纳入了 8334 名年龄≥18 岁、由大型医疗机构承保的 ACHD 患者（2007-2011 年）。在该机构数据库中，通过诊断和治疗记录来确定抑郁/焦虑的情况。采用负二项式模型估计调整后的利用率相对比率（RR），采用 Cox 比例风险模型估计死亡率风险比（HR）。
患有抑郁/焦虑症（N=2950 例，占 35%）的 ACHD 患者年龄更大（平均值±标准差：54±17 岁 vs. 45±18 岁）、女性比例更高（61% vs. 45%），且合并症发生率高于无抑郁/焦虑症的患者。经过多变量调整后，与无抑郁/焦虑症的患者相比，有抑郁/焦虑症的患者接受了更多的初级保健和心脏病学诊所就诊、更多的急诊就诊和更多的住院治疗。在研究前诊断时，RR（95%置信区间）分别为：1.31（1.27-1.35）；1.07（1.01-1.13）；1.60（1.46-1.77）；1.18（1.08-1.29）；在研究期间诊断时，RR 分别为：1.36（1.31-1.42）；1.22（1.14-1.30）；1.43（1.24-1.60）；1.47（1.33-1.64）。根据年龄分层，18-24 岁患者的调整后初级保健和心脏病学就诊 RR 最高，而≥65 岁患者的 RR 最低。在 2007 年至 2017 年期间，有 905 名患者死亡。抑郁/焦虑与调整后死亡率风险增加相关，HR 分别为：过去诊断时的 1.10（95%CI：0.94-1.29）和研究期间诊断时的 1.40（1.17-1.67）。
ACHD 患者的抑郁/焦虑与医疗保健利用率增加和死亡风险增加相关。进一步评估解决患者的心理社会需求以优化医疗保健利用率和改善预后的效果是必要的。
